Millions of Americans choose soft drinks as their beverage of choice 1. Recently, questions have been raised about the relationship between soft drinks and the development of chronic conditions (such as type b diabetes and heart disease) 1, and negative health outcomes (including obesity, weight gain and poor overall diet quality)2. Data also shows that diet soft drinks made with artificial sweeteners may not be a better alternative 1.

What are Soft Drinks?

Soft drinks, also known as sugar-sweetened beverages (SSBs), are beverages that usually contain water, a sweetener, and a flavoring agent (Wikipedia). The term soft drink comprises not only sodas, but also other sugar sweetened beverages, such as iced tea, lemonade and fruit drinks 3, powdered drinks, sports drinks and energy drinks 1. Sodas are sugar sweetened carbonated beverages, such as colas 3. The sweetening agent used in soft drinks can be sugar, high-fructose corn syrup, fruit juice, or sugar substitutes. They may also have caffeine, colorings or preservatives. 4

Carbonated soft drinks comprise the leading source of added sugars in the American diet 5. According to the 2005-2008 NHANES survey, one half of the US population consumes a sugary drink every day. Consumption varies by sex, age, ethnicity and socioeconomic status. For instance, males consume more than females and teens/young adults drink more than other age groups. Non-Hispanic blacks consume more than Hispanics, who consume more than their non-Hispanic white counterparts. Further, higher income levels consume less sugar drinks than those of a lower income status. Outside the home, most of the sugar drinks are consumed in stores rather than restaurants or schools. 2

Soft Drinks and Overall Diet

Research shows that soft drinks displace some vital nutrients. When individuals consume soft drinks, they tend to eliminate other important foods from their diet. 6. As a result, there is a decrease in the intake of numerous vitamins, minerals, and dietary fiber 6. For example, there is decreased calcium intake, decreased intake of protein, fruit juice, fruit, and riboflavin 7. Boys who drink more soft drinks consume less milk, which may lead to a decreased intake of calcium and an increased risk of osteoporosis. 6 Additionally, the caffeine found in many soft drinks is an addictive stimulant that increases unwanted calcium excretion 6. In fact, there is 20 mg loss of calcium for every 12-ounce can of caffeinated soft drink 6. Colas also have high levels of phosphates, which can throw off the bones’ balance of calcium and phosphorus and negatively affect bone growth and development 1.

Soft Drinks and Obesity

Increased weight gain is also linked to soft drink consumption 6. This is because added sugars are “empty calories” and do not contribute any nutrients required for the body. Instead, these calories are “extra” and contribute to gaining weight 8. SSBs are considered a major contributor to obesity because these drinks have low satiety value, high sugar, and incomplete total energy 3. One 12 ounce can of regular soda contains 8 teaspoons worth of sugar, which equals 130 calories and 0 nutrients 8. The AHA recommends a daily maximum sugar intake of c teaspoons of sugar equaling 100 kcal for women and 9 teaspoons equaling 150 kcal of sugar for men. 8

Further, there is a link between body size and SSB intake. Those individuals larger in size consume more soft drinks. Additionally, those who consume soft drinks tend to have increased overall calorie consumption 7.

In the US, about 129.6 million people are overweight, and 30% of those are considered obese 3. Obesity is link to many co-morbidities, such as hypertension, diabetes, cardiovascular disease, depression and certain cancers 3. Over the past b0 years, the percentage of those overweight or obese has increased along with the intake of carbohydrates, especially in the form of added sugar. 3

Soft Drinks and Diabetes and Heart Disease

Research has also shown an association between soft drinks and an increased risk of diabetes 7. In fact, one Japanese study showed that the consumption of soft drinks was related to an increased risk of type b diabetes in women 9. In the Framingham Heart Study, individuals who consumed at least one soft drink per day were 25% more likely to have increased blood sugar levels and 50% more like to develop Metabolic Syndrome 1. Metabolic Syndrome is a group of conditions that increases the risk for developing diabetes, stroke and heart disease. Metabolic Syndrome is present if an individual has three or more of the following: high blood pressure, high blood sugar, large waist circumference, low HDL cholesterol, and high triglycerides 10.

Both obesity and diabetes are risk factors for developing heart disease 1. Individuals have an increased risk of heart disease with high sugar diets because the sugar causes both their triglycerides and level of insulin to rise. High triglycerides are linked to a higher risk of diabetes and heart disease 6. Additionally, a recent study found that there is an association between consuming soft drinks daily and negative vascular outcomes, showing that individuals who drink diet soft drinks on a daily basis may have an increased risk of suffering vascular events such as stroke, heart attack and vascular death 11.

Soft Drinks and Dental Problems

Another negative effect of soft drink consumption is increased dental problems. People who consume more soft drinks have a higher incidence of dental caries and tooth erosion 12. This is especially true for low-income minority families who do not have access to adequate preventative dental care 6. Tooth decay occurs because of the sugars in soda and tooth erosion takes place because of the phosphoric acid contained in many sodas 6. Frequent soft drink consumption between meals allows the teeth to be in contact with the sugar and acid for long time periods during the day 6

Soft Drinks and Kidney Stones

There is also a possible connection between individuals who drink soft drinks and kidney stones. More research needs to be done in this area, but preliminary research indicates less recurrence of kidney stones when individuals consumed less cola 6.

Soft Drinks and Children

Children are especially vulnerable. Over half of children in school consume a soft drink daily 5. Further, the risk of becoming obese increases 1.c times for every sugar drink consumed 5. Additionally, soft drink consumption increases the risk that a young girl will develop osteoporosis. Bone mass is built early in life; in fact, by age 18, girls have built 9b% of their bone mass. If these girls do not get enough calcium in their developmental years, they cannot fix the problem as an adult. Also, drinking less milk and more soft drinks can contribute to broken bones in children. 6. The caffeine in soft drinks also affects the attention span and performance of children. For example, they tend to be more restless, have difficulty sleeping and demonstrate increased nervousness and fidgety behaviors. 6. Additionally, some of the additives in soda may cause allergic reactions and ADHD in children. 6

Negative Effect of Diet Soft Drinks

While it seems that substituting diet soda for regular cola might avert problems with diabetes or obesity, long term data is unclear, but a few studies have shown a link between diet drink consumption and obesity 13. Diet soda contains artificial sweeteners and has fewer calories than regular soda. However, the brain doesn’t register diet soda as food and therefore a person will not feel satisfied after a diet soda and may still have cravings and be tempted to eat extra food 14.

There are also risks with the artificial sweeteners found in diet soda 14. Some artificial sweeteners are aspartame (Equal, NutraSweet), saccharin (Sweet’N Low) and Sucralose (Splenda)15, acesulfame-K (Sunett, Sweet One), and neotame 1. There is some data linking aspartame to an increased cancer risk 14. However, the long-term effects of consuming artificial sweeteners are unknown 1.

In conclusion, children and adults are both at increased health risks when they consume both regular and diet soft drinks. The evidence indicates that decreasing or eliminating soft drinks will probably help with weight control and the prevention of diabetes. The evidence for diet drinks is not as defined, but they should also be avoided.

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